Dear Mental Health Practitioners, Take Care of Yourselves: a Literature Review on Self-Care (2020)

International Journal for the Advancement of Counselling (2020) 42:1 – 20

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fewer difficulties in emotion regulation (Finlay-Jones et al. 2015). Having an attitude of self compassion and acceptance helps therapists to recognize and address their professional limitations (Patsiopoulos and Buchanan 2011). In fact, engaging in professional development on a regular basis is recommended for therapist self-care (Knapp et al. 2017), and is increasingly being made mandatory by professional associations. Other practices that can promote flexibility are setting and reappraising goals (Wityk 2003), engaging in expressive writing or journaling (Baddeley and Pennebaker 2011; Warren et al. 2010), and engaging in Acceptance and Commitment Therapy (Rudaz et al. 2017). Self-care in relation to physical health encompasses a focus on issues of sleep, exercise, and diet (Harrison and Westwood 2009). Due to the sedentary nature of therapy work, practitioners can experience physical health concerns (Smith et al. 2014), with tiredness, and neck and back pain being the most frequently reported physical health symptoms by psychologists in training (Kaeding et al. 2017). In another study, clinical graduate students reported greater fatigue and more frequent headaches, back pain, and irritable bowel symptoms on a bi-weekly basis, as compared to the general population (Rummell 2015). In turn, physical health problems can have a negative impact on practitioners ’ client work, especially in regard to the therapeutic alliance (Kim et al. 2011). Sleep issues are prevalent among mental health practitioners. In a study by Schlarb et al. (2012) 44 % of psychotherapists were found to be suffering from symptoms of insomnia. Stress significantly reduces the quantity and quality of sleep, with poor sleep in turn triggering greater stress the next day (Åkerstedt et al. 2007). Insufficient sleep is linked to exhaustion and low professional efficacy (Wolf and Rosenstock 2017), higher levels of stress (McKinzie et al. 2006) and clinical levels of burnout (Söderström et al. 2012). For example, nurses who slept less than six hours per working day had a higher risk of job strain and burnout (Chin et al. 2015). Further, sleep deprived individuals tend to select less demanding challenges and tasks (Engle-Friedman et al. 2003), and so mental health practitioners may not be providing their best care for clients. To prevent negative outcomes such as burnout, practitioners can actively engage in sleep hygiene techniques. Maintaining a regular sleep schedule and getting ample sleep each night is recommended to promote well-being (Barnett et al. 2007). Specifically, self-monitoring sleep habits is an effective method of improving sleep hygiene (Mairs and Mullan 2015). Other effective sleep hygiene techniques include maintaining a regular sleep schedule, making one ’ s sleep environment restful, and avoiding going to bed hungry or thirsty (Mairs and Mullan 2015). Exercise and diet are equally critical components of self-care. Psychologists often recom mend a balanced diet and physical activity to their clients (Burton et al. 2010); however, it is unclear how dedicated they are to this aspect of their own self-care (Norcross and Guy 2007) – even though maintaining a healthy lifestyle is ranked as the fourth most important self-care practice by experienced therapists (Thériault et al. 2015). In addition to maintaining a balanced diet and attending to hydration on a daily basis, it is recommended that mental health practitioners exercise regularly (Harrison and Westwood 2009). Empirical research on helping professionals and general populations highlight the psychological benefits of physical health. For example, medical students who exercise, regularly reported less exhaustion and greater professional efficacy (Wolf and Rosenstock 2017), and lower rates of burnout and higher Physical Health